Letter Of Recommendation For Residency Applicants Made Simple

Process of letter of recommendation made simple

For the applicant

1. Select your referee well – don’t just select anybody who is willing to write a letter. Select someone who knows you and is willing to work with you to draft the letter
2. Discuss your goals with the letter writer – both professional goals and the goal of getting into a residency. Many a times the referees do not have a clue as to what they need to write for residency applications – guide them in this matter.
3. Discuss if you want to have a letter unique to a specialty or you want a relatively not specialized letter OR you can ask for both!
4. Provide clear cut instructions on how to write the letter, how long, what to write, what to include and how to sign etc (blue ink versus black ink)
5. Provide detailed instructions on what they need to do with the letter after they are done writing. Be explicit in letting them know NOT to mail it back to you but to send it to ERAS

For the referee (letter writer)

1. They must be reputable and be heavy hitters (medical director, Dean, higher up administrators etc)
2. Preferably in the US medical system – but if not possible to get US LOR then its still is OK
3. Can back up your recommendation letter with personal phone call if needed
4. Believe in you
5. Knows you personally
6. Can comment on who you are as a person and who you can do

For the letter of recommendation itself

1. Must be on a professional or institutional letterhead – just looks official!
2. Must include contact information should the PD or program decide to call and verify – they can do that and they definitely do (not all cases but those they have selected to match into the program)
3. Must be meaningful in content – hence discuss with the writer how you want to proceed with the letter
4. must make a note of personality, professionalism, leadership quality, interpersonal behavior, clinical and personal skills that make you unique.
5. May waive or chose to not waive the letter – I recommend to waive if possible.
6. The importance of letter depends on where it is issued from, check out the order of importance of LoR to make sure you have one which makes the highest impact.

This is it, as simple as it can get. Start working on the process of getting a super stellar LOR and it will help you secure interviews for residency. Remember Deans letter (MSPE) is not considered as a letter of recommendation. Hopefully these pointers will help you secure a wonderful letter of recommendation and help match into a good program. If you wish to be in touch and get the latest posts and updates, join me on Facebook or follow me on Twitter.

J1 waiver options for medical residency applicants

What is J1 visa?

J1 visa or the visitor exchange visa is one type of visa granted to those wishing to pursue medical residency in US. It is a non-immigrant visa with the sole purpose of providing education, learning or training to individuals from outside US. The basis of the two year home return rule comes form Section 40.202 dealing with foreign exchange visitors in the code of federal regulations which in essence states that

An alien who was admitted into the United States as an exchange visitor, or who acquired such status after admission, is not eligible to apply for or receive an immigrant visa or a nonimmigrant visa [H, K, or L]. unless: It has been established that the alien has been physically present in the country of the alien's nationality or last residence for an aggregate of at least 2 years following the termination of the alien's exchange visitor status.

The reason in part this was instituted because this visa category is supposed to be an open channel of exchange of skilled and professional personnel between US and other countries. The agreement, so it seems is - to prevent trained professionals from leaving home country after training on either side, it was made mandatory for these exchange visitors to return to home country.

What  is a J1 waiver?

There are certain exceptions which can be applied to the above stipulation of the 2 year home country return requirement. US department of state website mentions 5 criteria for waiver but in effect there are only four basic ones (Figure 1).

Figure 1: Green arrows denote the vector of retention of J1 applicants.

• Factors that are US related
• Need for state or federal agencies to fill positions where the expertise of the applicant is needed
• separation of J1 applicant with his family (who is US based citizen or GC holder) which will cause extreme hardship to family

• Factors that are home country based
• Home country has no objection to you not coming back
• There is fear of persecution in home country for the applicant.

Which factors are applicable to medical residency applicants?

No objection certificate (NOC) criteria from home country for one is NOT applicable to IMGs which leaves the other three as possibilities for waiver. The most commonly used exception is the need for US or state agencies to have physicians in the underserved area. There is a big demand for providers in the HPSAs (health professional shortage areas) but not all physicians are favored. The preferred physician categories are

1. Primary care
1. Family medicine
2. Internal medicine
3. Pediatrics
4. Ob/gyn
5. geriatrics
2. Dentist
3. Psychiatrist

It is clear from above list that if your specialize or do a fellowship - the chances that you will find a waiver job will considerably go down. Think about this before you chose your professional career plans.

The HPSAs can also be geographic (a county or service area), demographic (low income population) or institutional (comprehensive health center, federally qualified health center or other public facility). The complete list of HPSAs can be found at the Health Resources and Services Administration website. There are also a list of MUPs (medically underserved populations) and MUA (medically underserved which are eligible for waiver jobs. Applicants can also apply to these areas under the CONRAD 30 waiver program  or under certain circumstances, the Appalachian Regional Commission (ARC)will request a waiver of immigration requirements for foreign-trained physicians doing residency work in the United States under a J-1 visa. For the flowchart discussing the J1 waiver process check out at J1 waiver requirementmade easy.

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Lost your ECFMG certificate? Here's some help

After extensive internet investigation I have finally landed on what seems like the straight forward way to get a duplicate certificate from ECFMG. I dont know why this is not easily available for applicants to find on the ECFMG website. I have seen several questions being posted on forums and message boards with no direct answers. Either the folks who got their reissued certificates just called in to ECFMG and got that worked out or they did not leave an answer of how it was done.

In any case, here is the way to request ECFMG to reissue a certificate if you have lost the original one.

1. Download the payment for service(s) request form, also called as FORM 900
2. Indicate the service you are providing payment for - this case it will be the box marked duplicate certificate.
3. Pay by check, card or money order
4. send the form to ECFMG

BY MAIL: ECFMG, PO Box 13679, Philadelphia, PA 19101-3679 USA
BY COURIER: ECFMG, 3624 Market Street, Philadelphia, PA 19104-2685 USA
TELEPHONE: (215) 386-5900 • FAX: (215) 386-3185 • INTERNET: www.ecfmg.org

Here is the screen shot of the form for additional help.